Synthetic cannabinoids are known to the general public by names such as “synthetic marijuana,” “fake pot,” and “fake weed.” This misnomer implies that synthetic cannabinoids are similar to marijuana, but nothing could be further from the truth. Although the green, leafy organic material containing synthetic cannabinoid chemicals may look similar to marijuana, this is where the likeness distinctly ends. A growing number of hospitalizations and even deaths have been reported to be associated with the use of these synthetic chemicals. Mr. Happy, Hulk, Kush and Scooby SNAX contain a randomly mixed product sprayed or coated with dangerous chemicals that can have a devastating effect.

How do we know there is a problem? There was a 225% increase in exposure calls at poison centers nationwide related to synthetic cannabinoids when comparing January through May of 2014 to the same time period in 2015. The total number of cases rose from 1,115 calls in 2014 to 3,621 in 2015.

In Texas, data from the Texas Poison Center Network revealed an increase in exposure calls related to synthetic cannabinoid. The total number of exposure calls related to synthetic cannabinoids for 2013 was 464 compared to 782 in 2014. This is an increase of 69% percent.

Now commonly referred to by names such as “synthetic marijuana,” “fake pot” and “legal weed,” synthetic cannabinoids have continued to grow in popularity since they became available in the United States in 2008. Some of the brand names for these products, such as K2, Spice, and Kush, have now become generic terms used synonymously for this drug type. The upward trend in the use of synthetic cannabinoids is believed to have occurred because they are relatively inexpensive, they do not show up on standard drug screening tests, and, although many synthetic cannabinoids are now illegal, there is still a common misconception that these products are a safe, legal alternative to marijuana.6 The fact that some of these products are still openly sold in convenience stores, gas stations, smoke shops, and on the Internet adds to the confusion about their safety and legality.7,8,9

What is Actually Inside These Packets?

Synthetic cannabinoid products consist primarily of dried organic material that has been sprayed with a synthetic cannabinoid chemical and often, a fragrant flavoring.* Unfortunately, because they are marketed as “herbal” products, many users tend to equate the word “herbal” with safe. These packets of synthetic drugs may look professional on the outside, but nothing could be further from the truth about the product on the inside. Even though some synthetic cannabinoid products are still being sold out of legitimate businesses such as convenience stores and smoke shops, these packets are actually being assembled by criminals out of garages, storage facilities, and warehouses. They are motivated purely by profit and have no regard for the health or well-being of consumers.

*Note: Another form of the drug that is currently less popular is liquid synthetic cannabinoid oil that is used in conjunction with e-cigarettes.

The synthetic cannabinoids being used in these products are primarily produced by chemists in China, and to a lesser extent, in other countries in Southeast Asia such as India.12 Dealers order these chemicals in a powdered form over the Internet, as can be seen in the accompanying photographs.

The synthetic cannabinoid powder is then mixed generally in 5, 10, or 20 gallon buckets with a solvent such as acetone, and often a fragrant flavoring such as strawberry or apple to create a liquid form of the chemical that will then be used to saturate the organic material. In some instances, large mixers are used for this process.

Mullien or Damiana leaves are commonly used as the organic material in these products. These leaves are ground up into a fine tobacco-like substance. The leaves are either added to the buckets or mixers along with the chemical compound so that they become saturated or they are sprayed with the liquid chemical mixture using industrial spray bottles. The leaves are placed on drying tables, as can be seen in the photo to the left, and then the final product is packaged for distribution.

“Hot Spots” and Other Quality Control Issues

Since there are no quality control checks or safety measures taking place in these clandestine manufacturing operations, there is really no way to know exactly what is in these drug-filled packets. The amount and type of chemicals can vary from one package to the next. Even identically labeled packets may actually contain differing amounts and/or types of synthetic cannabinoids. Additionally, the potency can vary from dose to dose, even within the same packet. “Hot spots” in which higher concentrations of the chemicals have been applied may be present in some portions of the organic matter but not others. Most commonly, hot spots occur due to uneven spraying of the leafy material if the chemical was applied by hand using spray bottles or uneven mixing if the product was combined in a bucket or industrial mixer. The higher potency of these hot spots is of particular concern from a public health safety standpoint.

Finally, because new synthetic cannabinoids are always being created to replace those that become banned, the chemicals that are in a packet of “Scooby Snax” today are not likely to be the same synthetic cannabinoids present in this brand in the near future. Thus, the same brand purchased at different times may have a completely different chemical composition and produce very different effects in the body.

Education and Prevention Efforts

To adequately address the widespread public health threat from synthetic cannabinoid abuse, a multi-faceted approach is necessary. While legislation and enforcement efforts will likely reduce the supply of synthetic cannabinoids, education to increase public awareness of the danger of using these drugs is also paramount to reversing this perilous drug trend.

Federal Prevention Efforts

Prevention and educational efforts are taking place at the federal, state, and local levels. For example, at the federal level, the Office of National Drug Control Policy (ONDCP) at the White House, in conjunction the Partnership for Drug Free Kids, has created a Synthetic Drug Prevention Information Toolkit to serve as a resource for parents to use when talking with teens about the dangers of synthetic drugs and to help them recognize the warning signs of synthetic drug use. This toolkit can be found on the www.drugfree.org website. It includes a slidecast, podcast, video, and printable guide.81,82,83 ONDCP also hosted a webinar on synthetic drugs in April of 2015. This webinar covered an introduction on the newest synthetic drugs focusing on their manufacture, distribution, and health risks. It also provided details on federal and local efforts to reduce the threat, and federal regulatory provisions and enforcement actions. A second webinar will be held in the future that will focus on local efforts to prevent the use and distribution of synthetic drugs. It will highlight specific community reduction initiatives.84.85 Another federal prevention effort aimed at increasing public awareness about the dangers of synthetic drugs included the designation by Congress of the week of March 9th through March 15th, 2014 as National Youth Synthetic Drug Awareness Week.86 This resolution urged communities to carry out appropriate programs and activities to educate parents and youth about the dangers associated with synthetic drug abuse.87

Other Prevention Efforts

Safe4Emily (Website and Facebook Page)

As mentioned earlier, Emily Bauer and her mother, Tanya Bauer from Houston, Texas have created a website called Safe4Emily.org (Synthetic Awareness for Emily). They have also established a Facebook page (www.facebook.com/safe4emily) to inform the public about the serious health risks associated with the use of synthetic cannabinoids. They travel across the state educating others about the irreparable damage that can occur after use of these drugs, using Emily’s story of ongoing physical and mental impairments from using “synthetic marijuana” as a way to reach others with prevention messages such as the one on their Facebook page (above).54,88,89K2 Drug Facts (Website)

Families who have lost teens to synthetic drugs have also established websites aimed at prevention and education. The K2drugfacts.com website was established by the parents of David Rozga, a teenager from Iowa who died after using a synthetic cannabinoid product. They created this website to serve as an alert to the public of this dangerous drug threat with the hope that other lives might be saved. Shortly after his high school graduation, 18 year-old David decided to try K2 (a brand of synthetic cannabinoid). He became very agitated, and ninety minutes later, committed suicide. There was no evidence that he was suicidal prior to using the drug. His family firmly believes that if David had known about the effects of this drug, he would never have smoked it and would be alive today. They want others to use their website to obtain facts and resources about synthetic drugs and to learn from David’s story before it is too late, as was the case for their son.90,91

To The Maximus Foundation (Website)

The “To the Maximum Foundation” is a non-profit organization committed to the education and awareness of the dangers of synthetic drugs. It was founded by the family of Max Dobner, a 19 year-old young man from northern Illinois. Sadly, Max was yet another teenager who died after smoking a synthetic cannabinoid. He had purchased the drug legally from a shop in a local mall. After using the drug, he began driving his car erratically at speeds of up to 80-100 miles per hour, and ultimately drove his car into a house, killing him instantly. This tragedy illustrates not only the dangers of synthetic cannabinoids to the individual using the drug, but also the serious threat to public safety.92 The “To the Maximum Foundation” website addresses are http://2themax.org and http://www.tothemaximusblog.org.